Atlas of Surgical Approaches to Paranasal Sinuses and the Skull Base

Description:

This richly illustrated atlas, compiled by authors with extensive experience in the field, offers a step-by-step guide to the surgical treatment of tumors, and congenital diseases of the skull base and nasal sinuses. Particular attention is devoted to the various techniques employed for extirpation of tumors and reconstruction of the skull base and Paranasal Sinuses. In order to facilitate understanding of the different approaches, clear surgical illustrations are presented alongside the high-quality intraoperative photographs. Whenever appropriate, technical tips are provided and briefly discussed. This atlas will appeal to a broad audience of residents, fellows, and consultants in different fields of medicine, including surgeons (head and neck, neurosurgery, otolaryngology, plastic and reconstructive surgery, ophthalmology, maxillofacial surgery) and oncologists.

Table of Contents:

1: The Cranial Base

1.1 Overview

1.2 Anterior Cranial Base

1.2.1 Endocranial Surface

1.2.2 Exocranial Surface

1.2.3 Endoscopic Endonasal Anatomy

1.3 Middle Cranial Base

1.3.1 Endocranial Surface

1.3.2 Exocranial Surface

1.3.3 Endoscopic Endonasal Anatomy

1.3.3.1 Sellar and Parasellar Areas

1.3.3.2 Cavernous Sinus and Meckel Cave

1.3.3.3 Infratemporal Fossa and Parapharyngeal Space

1.4 Posterior Cranial Base

1.4.1 Endocranial Surface

1.4.2 Exocranial Surface

1.4.3 Endoscopic Endonasal Anatomy

1.4.3.1 Clivus

1.4.3.2 Foramen Magnum and C1 and C2

1.5 Discussion

Selected Reading

2: Anterior Skull Base: Imaging

2.1 Imaging Modalities

2.1.1 Imaging Approach and Protocols

2.1.2 Computed Tomography

2.1.3 Magnetic Resonance Imaging

2.1.4 Cross-Sectional Angiographic Imaging

2.1.5 Positron Emission Tomography

2.2 Imaging for Initial Diagnosis and Staging

2.2.1 CT Scans

2.2.2 MR Imaging

2.2.3 PET/CT

2.2.4 MRI (Standard Imaging)

2.3 Dural, Perineural, and Venous Sinus Invasion by Skull Base Tumors

2.3.1 Dural Invasion

2.3.2 Direct Extension and Distant Metastasis

2.4 Pathology

2.4.1 Infection and Inflammation

2.4.2 Tumors: Sinonasal Masses

2.4.3 Meningiomas

2.4.4 Primary Osseous Tumors

2.4.5 Imaging During Follow-Up

Suggested Reading

3: Operating Room Setup in Skull Base Surgery

3.1 Introduction

3.2 Preoperative Evaluation and Anesthesia

3.3 Patient Positioning

3.3.1 Open Approaches

3.3.2 Endoscopic Approaches

4: Open Surgical Approaches to the Paranasal Sinuses

4.1 Preoperative Evaluation and Anesthesia

4.2 Surgical Technique

4.2.1 Transfacial Approaches

4.2.1.1 Lateral Rhinotomy Incision

4.2.1.2 Dieffenbach and Subciliary Incisions

4.2.1.3 Combined Lateral Rhinotomy and Dieffenbach Incisions

4.2.1.4 Weber-Ferguson Incision

4.2.1.5 Lynch Incision

4.2.2 Transfacial Subtotal Maxillectomy

4.2.3 Midfacial Degloving Approach

4.2.4 Suprastructure Maxillectomy

4.2.5 Suprastructure Maxillectomy with Orbital Exenteration

4.2.6 Total Maxillectomy and Orbital Exenteration

4.2.7 Combined Total Maxillectomy with Infratemporal Fossa Approach

4.2.8 Maxillary Swing Approach

4.2.9 Le Fort I Down-Fracture Osteotomy

4.3 Reconstruction

4.4 Postoperative Treatment

4.5 Highlights: Open Surgical Approaches to the Paranasal Sinuses

Suggested Reading

5: The Subcranial Approach to the Anterior Skull Base

5.1 Preoperative Evaluation and Anesthesia

5.1.1 Operative Room Setting

5.2 Surgical Technique

5.3 Reconstruction Following Subcranial Surgery

5.4 Postoperative Treatment

5.5 Highlights

Suggested Reading

6: Surgical Approaches to the Lateral Skull Base

6.1 Introduction

6.2 Preoperative Evaluation and Anesthesia

6.2.1 Physical Examination

6.2.2 Indications for Surgery

6.2.3 Contraindications

6.2.4 Imaging Studies

6.2.5 Tissue Diagnosis

6.3 Surgical Technique

6.3.1 Operating Room Setting

6.3.2 Skin Incision

6.3.3 Vascular Control and Identification of Cranial Nerves

6.3.4 Pterional Approach

6.3.5 Infratemporal Fossa Approach

6.3.6 Orbitozygomatic Approach

6.4 Postoperative Treatment

6.5 Highlights

Suggested Reading

7: Approaches to the Parapharyngeal Space

7.1 Introduction

7.2 Preoperative Evaluation and Anesthesia

7.2.1 Imaging Studies

7.2.2 Tissue Diagnosis

7.3 Surgical Technique

7.3.1 The Transcervical Approach for Resection of PPS Tumor

7.3.2 The Transparotid Approach for Resection of PPS Tumor

7.3.3 The Transcervical-Transparotid Approach

7.3.4 The Transmandibular Approach

7.3.5 Transoral Robotic Surgery

7.3.6 Transcervical Endoscopic

7.4 Postoperative Treatment

7.5 Highlights

Suggested Reading

8: The Translabyrinthine Approach to the Internal Auditory Canal and Cerebellopontine Angle

8.1 Introduction

8.2 Indications for the Procedure

8.2.1 Vestibular Schwannomas: Epidemiology, Presentation, and Diagnosis

8.2.2 The Place of the TL Approach in VS Treatment

8.3 Surgical Technique: Translabyrinthine Approach for Resection of Vestibular Schwannoma

8.3.1 Perioperative Preparation in the Operating Room

8.3.2 Soft-Tissue Incisions and Flaps

8.3.3 A Wide Mastoidectomy (Canal Wall-Up or Canal Wall-Down)

8.3.4 Removing All Bone over the Posterior and Middle Fossa Dura

8.3.5 Systematic Labyrinthectomy

8.3.6 Removing the Bone Surrounding the IAC

8.3.7 Opening the IAC and CPA Dura

8.3.8 Tumor Removal

8.3.9 Obliterating the Surgical Defect

8.3.10 Closure

8.4 Postoperative Care

8.5 Complications

8.5.1 Facial Nerve Dysfunction

8.5.2 Cerebrospinal Fluid Leakage

8.5.3 Meningitis

8.5.4 Intracranial Hemorrhage

8.5.5 Headaches

8.6 Outcome and Follow-Up

8.7 Highlights

References

9: Cancer of the Temporal Bone

9.1 Introduction

9.2 Evaluation

9.3 Staging

9.4 Treatment

9.4.1 Surgery

9.4.1.1 Lateral Temporal Bone Resection

9.4.2 Reconstruction

9.4.3 Radiation Therapy

9.4.4 Hearing Loss

9.5 Outcome

Conclusion

9.6 Highlights

References

10: Endoscopic Approaches in Skull Base Surgery and Their Indications

10.1 Introduction

10.1.1 The Inferior and Superior Limits of the Endonasal Approach

10.2 Surgical Technique

10.2.1 The Expanded Endoscopic Approach

10.2.2 Approach to the Sphenoid Sinus and Planum

10.2.2.1 Surgery of the Sella and Posterior Sphenoid Sinus Wall

10.2.2.2 Sellar and Suprasellar Craniotomy

10.2.3 The Transplanum, Perichiasmatic Approach

10.2.4 The Endoscopic Transnasal Transcribriform Approach

10.2.5 The Endoscopic Transmaxillary/Retromaxillary Approach

10.2.6 The Endoscopic Transclival Approach

10.2.6.1 Identification of the Internal Carotid Artery at the Paraclival Area

10.2.6.2 Approaches to the Clivus and Cervical Spine

10.2.7 Endonasal Reconstruction of the Skull Base

10.2.7.1 The Nasal Septal Flap

10.2.7.2 The Inferior Turbinate Flap

10.2.7.3 Pericranial and Temporoparietal Fascia Flaps

References

11: Combined Approaches to Complex Skull Base Tumors

11.1 Introduction

11.2 Surgical Technique

11.2.1 Combined Transorbital–Transcervical–Infratemporal Fossa Approach

11.2.2 Combined Transfascial–Transorbital–Pterional Approach

11.2.3 Combined Transmandibular–Infratemporal Fossa Approach

11.2.4 Combined ITF–Transcervical Approach

11.2.5 Combined Temporal Bone Resection and Far Lateral Approach

11.3 Reconstruction

11.3.1 Postoperative Treatment

11.4 Special Considerations for Combined Approaches

Suggested Reading

12: Microsurgical Reconstruction of Skull Base Defects

12.1 Introduction

12.2 Anatomical Considerations

12.3 Reconstruction Method

12.3.1 Analysis of the Defect and Considerations

12.3.2 Flap Variations

12.3.2.1 Anterolateral Thigh Flap

12.3.2.2 Radial Forearm Free Flap

12.3.2.3 Rectus Abdominis Myocutaneous Free Flap

12.3.2.4 Additional Flaps

12.3.3 Recipient Vessels

12.4 Postoperative Protocol and Flap Monitoring

12.5 Complications

12.5.1 Surgical Site Complications

12.5.2 Donor-Site Complications

12.5.3 Medical Complications

12.6 Specific Considerations for Microsurgical Reconstruction of Skull Base Defects

12.6.1 Anterior Cranial Fossa Reconstruction

12.6.2 Middle Cranial Fossa Defect Reconstruction

12.6.3 Posterior Cranial Fossa Defects

Conclusions

Suggested Reading

13: Complications After Skull Base Surgery

13.1 Introduction

13.2 Risk of Complications after Anterior Skull Base Tumor Resection

13.3 Specific Complications

13.4 How to Avoid Complications

13.5 Highlights

Suggested Reading